10th Newsletter...

10th Newsletter

Preface

Dear colleagues and friends,

as I stated in my last report, I am pleased to inform you that the financial situation of the European Society of Neurosonology and Cerebral Hemodynamics is stable and sound. Enclosed you can find the balance of the account of the Society for the year 2005.

The membership of the ESNCH has been growing constantly. In comparison with the previous years, I am happy to inform you that the payment morality regarding membership fees has improved considerably last year. Thank you very much for your support of our Society.

As in 2004, also in the year 2005 the current costs of the Society (which continue to be kept at a minimum level) could be covered fully by the income from membership fees. In comparison to the year 2004, this income increased by 11.2%. On the attached graph, you can follow the development of the income from membership fees since the year 2000.

Please let me make a practical suggestion in this connection. It is sometimes impossible in the case of foreign bank transfers to match the membership fee to the person. I would like to ask you therefore to make sure that the name of the member appears on the bank transfer. In the case of credit card transfers, please be sure that the complete number of your credit card and the expiration date are clearly legible on the membership form which you received. Your help on these points will be greatly appreciated.

I wish you a stimulating and pleasant stay in Düsseldorf during the 10th Meeting of the ESNCH.

Yours sincerely,

Eva Bartels

Report of the Treasurer

European Society of Neurosonology and Cerebral Hemodynamics
Summary of income / expenses for the period January 01, 2006 to December 31, 2006

Message of the resigned President

Dear colleagues, dear friends,

it was a tremendous honour and a most enjoyable time for me to serve as �President� of this European Society of Neurosonology and Cerebral Hemodynamics from 2001 up to now (2005). During this time, I have experienced an impressing friendship not only by the members of the executive committee, but also by many of you from all over the world. After having become designated president of this society in 2001 during our annual meeting organized by Dr. Victor Oliveira in Lisbon, I chaired the Executive Committee during another 4 meetings of this society, namely (1) in Bern under the organisational leadership of Prof. Mathias Sturzenegger, (2) in Alicante under the organisational chairmanship of Dr. Jose Manuel Molt�, (3) in Wetzlar under the chairmanship of Prof. Manfred Kaps and, now, (4) in Abano Terme under the organisational chairmanship of Dr. Giorgio Meneghetti. These great names guaranteed great events. It is their merit that the society was so successful. It is my honour and pleasure to congratulate these organisers for their excellent work and for their tremendous help in pushing the society forward by increasing the attention paid to it worldwide.

When I started my position as president of the ESNCH, I made 2 main promises, i.e. (1) to further contribute to the success of this society and (2) to make a democratically based systematic revival and turnover of the Executive Committee become reality. Both aims have been reached. The number of members has increased considerably, and we know count 357 active members from 46 different countries in our society, nearly all of them in good standing. Also the finances of the society have been reorganised. We have now achieved on a good and satisfying level making the society even more successful in a challenging future. Our treasurer, Dr. Eva Bartels, has mostly contributed to this success.

On the basis of the formal registration in Oslo and the finances being organised in Munich, and together with the renewal of the bylaws, the society is in best shape at present. It was the merit of our secretary, Prof. J�rgen Klingelh�fer, as well as of our founding president, Prof. David Russel, to have promoted this development to the presently satisfying result. I would like to thank both of them for their excellent job. Needless to say, that Prof. Rob Ackerstaff and Prof. Kurt Niederkorn have provided a big amount of preparatory work over all the years to further fuel the progress of building up this society. Last not least, Prof. Nathan Bornstein has helped us a lot in the international context and in the development of the bylaws, all of whom I would also like to thank cordially.

The most particular donation, I have received during all these years, and which impressed me most, however, is your faithfulness to the society. You supported the ESNCH by your attendance to the meetings and your active contributions to the scientific sessions during the converences. Thank you all for this assistance and your enthusiasm.

Neurovascular ultrasound and other types of neuromedical ultrasound applications including B-mode imaging of the brain parenchyma, still are relatively novel and distinct diagnostic techniques. From my point of view, these techniques have a promising future with even more sophisticated applications in the neuromedical field like sonothrombolysis, parenchymal imaging in neurodegenerative diseases, and, particularly, in vasomotion and endothelium- smooth muscle cell�interactions. The latter applications have still not been explored deeply enough.
Another exciting field is ultrasound-based treatment by means of �smart bubbles� which are used in experimental settings to ship pharmaceutical compounds and genes or gene-vectors to predefined cerebral areas and circumscribed vascular beds. The future will tell us whether this approach will finally be successful. Progress is also seen in the secondary, mathematics-based exploration of ultrasound data like in functional TCD or other paradigms to functionally investigate the cerebral vasculature.

Thank you all for your great assistance and friendship.
Auf Wiedersehen, leben Sie wohl and good bye.

Conclusion of the 11th meeting of the ESNCH

11th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics University of Düsseldorf, Germany
May 14 th - 16 th, 2006
Organizing Chairman: Mario Siebler

Neurosonolgy is a hot topic in experimental and clinical medicine. The technology of the imaging is substantial improving and will allow us ultrasound to use up to molecular imaging, non invasive imaging of patients or even therapeutic applications. The ESNCH had the big chance to push this exciting developments. The society could have substantial impact on experimental basic research and clinical trials. It could be a platform for multi centre trials supported by EU grants as well as a mediator for international guidelines and education quality service.

Thus, to mange such a conference it is a great honour but also a challenge. In the last years tremendous development in cerebral imaging by CT and MRI had pushed the neurological diagnostic. In the meantime ultrasound (US) technology had also substantial improved in e.g. cardiac, abdominal, prenatal applications as well as in neurosonology. This is based on higher online image qualities, 3D/4D visualizations, B-flow, m-mode Doppler, improved low energy transducers, smaller and portable systems and the development of ultrasound contrast agents. Recent advances lead to level 1, type A evidence that TCD and carotid duplex are recommended elements of a comprehensive stroke center. The 11th Meeting of the European Society of Neurosonology and Cerebral Hemdodynamics (ESNCH) held in Düsseldorf reflected the current established applications of ultrasound and the basic studies in neurosonology. Most notable research focused on treatment amplification in acute stroke, parenchyma and peripheral nerve imaging, identification of high-risk patients, cerebral monitoring, carotid stenting, decisions for percutaneous patent foramen oval closure and first telemedical applications. Sonothrombolysis is one of the current exciting hot topics in neurosonology. Clinical trials demonstrated safe augmentation of TPA-associated thrombolysis with 2 MHz TCD, while one study using very low frequency ultrasound (TRanscranial low-frequency Ultrasound-Mediated thrombolysis in Brain Ischemia, the TRUMBI trial,4) had to be stopped due to severe side effects. Results of basic research experiments presented by Furuhata and Zajonz et al. strongly support the thrombolytic effect and safety of high frequency ultrasound. Clinical and experimental data suggest that the thrombolytic effect of rtPA may be further enhanced by gaseous microbubbles (5) and insonation with dual frequency probes. Two clinical trials, in US and EU, are addressed to clarify the clinical value in the next years. Neurovascular ultrasound may be helpful in multimodal patient selection for thrombolysis at an extended time window – beyong 3 hours after stroke onset- to detect and possibly predict arterial reocclusion. Reocclusion happens in more than 20% after thrombolyis and additional treatment e.g. platelet inhibition with gpIIb/IIIa antagonists may improve the outcome. Transcranial ultrasound imaging with TCCD is a further highlight. Significant results were presented by two research groups (Berg and Walter) in movement disorders providing evidence that the ultrasound hyperecho signal in the Nigral Substance is correlated to Parkinson Diseases, dystonia and multi system atrophy not seen in MRI or CT scans. Although it is not clear what the signal represents- may be related to iron metabolism- the current TCCD technique and the signal analysis is now ready for multi-centre studies to identify patients at risk. TCCD also provide cerebral parenchymal information in acute cerebral bleeding. Meairs showed for the first time real-time MI brain perfusion images of acute cerebral bleeding with high resolution. This opens the perspective to monitor the dynamic of cerebral bleedings and effects of acute treatments in stroke patients. Peripheral nerve imaging is a new field for neurologist supported by the high resolution of ultrasound even in the near field. As presented by Kele systematic investigation of nerve compression syndromes, e.g. carpal tunnel syndrome (CTS), demonstrate additional helpful information beside electroneurography. Symptomatic intracranial disease remains a global challenge with an annual risk of stroke in excess of about 12%. Here, TCCD help to identify patients with significant intracranial disease. Combination with ultrasound contrast agents improves substantially the success rate. The results of the EGLIBLE Study support the early bedside assessment of TCCD in stroke patients. Preclinical manifestation of high cardio-and cerebrovascular risk can be ascertained with duplex measurement of the well established intima-media thickness (IMT) in the carotid artery. Reports link increased IMT to inflammation as a potential new target in stroke prevention. Kelm reported about the validity of flow mediated dilatation (FMD) to measure endothelial dysfunction. These patients at high stroke risk may need special medical therapies to improve endothelial function. Horner and Sander stated that that TCD is accepted to select patients for patent foramen ovale (PFO) skipping echocardiography for shunt detection. On a controversial discussion with Anzolla, Sturzenegger and Budts on the subject of PFO valve closure after stroke and in patients with migraine additional clinical trials are need to define the appropriate patients which really benefits. Transcranial ultrasound application with measuring the cerebral autoregulation and microembolism help to identify patients with higher stroke risk. These methods were recommended by several groups for monitoring during CEA, stenting or cardiac surgery as Ackerstaff reviewed. First steps are made to use telemedical applications of US. Audiovisual interaction from doc to doc during ultrasound examination of patients had substantial improved the performance of low trained subjects. Tegeler proposed the remote signal analysis of TCD recordings for the dynamic vascular analysis. This is an attempts to improve and standardise neurosonological diagnostics. In summary, neurosonology had an exciting future in diagnostic and therapeutic application to help our neurological patients. We should further invest our efforts in this field. Acknowledgement: This article is dedicated to Merill Spencer, one of the shining example in our neurosonology community.

Mario Siebler
(Congress Chairman)

Conclusion of the 12th meeting of the ESNCH

The 12th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics happened between 26-29 May, 2007 in Budapest. The educational part of the conference has been accredited by both the European Federation of the Neurological Societies, and the European Accreditation Council for Continuing Medical Education.

This conference was the the first, when not only theoretical but also
practical exam (on patients!) was organized by the tutorial committee of
our society headed by Professor von Reuten.

Three-hundred-fourty-three participants came from 42 countries (including US, Brasil, Japan etc.) to the meeting. Eighty two participants attended the tutorial as well and 14 participants took successful
international exam on neurosonology. On the conference, 59 oral lectures were presented, and 132 posters demonstrated. Dr. László Oláh, the main local organizer did an excellent work by teaching course, providing well strutured teaching material and all necessary infos. The technical equipments worked without any failure and the audience was very active during the
scientific and also social parts of the program.

The wellness Hotel Helia was a perfect place for the lectures (first
floor), poster presentation (ground floor) and relaxing (excellent
wellness facilities). The Hotel was located on the bank of the Danube.

The performance of the dancing group during the opening ceremony and the reception on the ship (night-cruising on the Danube and wondering the flood-lighting of Budapest) with excellent food and music will remain probably in the memory of the participants.

The travel agency Altagra did an excellent job compensating the hot
weather with cool drinks, fruits and smooth organisation.